Abstract Details

Title Autonomic manifestations before and after renal denervation.

Topic Neuromuscular and Clinical Neurophysiology (EMG)

Presentation(s) P3 - Poster Session 3 (5:30 PM-6:30 PM)

Poster/Presentation
Number 7-064

Objective To describe autonomic findings after sympathetic renal denervation.

Background Refractory hypertension to treatment is considered when blood pressure persists above 140/90mmHg despite adequate doses of three or more antihypertensive medications. Renal denervation has been used to decrease sympathetic renal activation and reduce hypertension. However, controversy has arisen of the magnitude and persistence of this effect.

Design/Methods Twenty-one patients were included, 12(50%) men, with a mean age of 59 (39-79) years old. Three patients had studies that were difficult to analyze. All patients had refractory hypertension treated with 3 to four different anti-hypertensive drugs (76.1% with beta-blockers and diuretics, 47.6% with an antagonist of angiotensin II, and 14% with calcium antagonists). Autonomic testing was performed after 24 hours of beta-blockers withdrawal, with beat-to-beat monitorization for 10 minutes of supine baseline followed by head-up tilt (HUT). Protocol of tests included heart-rate variability after deep-breathing (HRdb), Valsalva maneuver and BP with HUT. The mean time between tests was 9.0±5 months after the procedure.

Results

Patients were taking a mean of four (2-5) different antihypertensive medications before surgery, and three (1-3) after surgery. Supine systolic, diastolic BP (140/81 vs. 141/79mmHg) and HR (74 vs. 72 bpm) did not change significantly after the procedure. However, HRdb was significantly different (mean 12.5bpc vs 9.5bpc, p=0.01, E:I ratio 1.19 vs 1.14, p=0.02). SBP fall at HUT was -13±30mmHg before and -23±32mmHg after denervation. The Valsalva ratio improved (1.4 to 1.6). SBP changed since minute one and continued to fall significantly at minute five after tilt (136 vs. 132mmHg at minute one, and 121 vs. 108 mmHg at minute five).

Conclusions Renal denervation decreased the use of medications in patients with refractory hypertension. Patients had orthostatic hypotension after denervation that persisted after nine months of renal denervation.

Authors/Disclosures
Maria Alejandra Gonzalez Duarte, MD, FAAN (NYU Dysautonomia Center) PRESENTER	Dr. Gonzalez Duarte has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alnylam. Dr. Gonzalez Duarte has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Astra Zeneca. Dr. Gonzalez Duarte has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Alnylam . The institution of Dr. Gonzalez Duarte has received research support from Pfizer.
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